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Local activists and residents in the Damascus countryside and Homs told Human Rights Watch in phone interviews that people are suffering from an increasingly severe shortage of food and that people are dying from lack of medical care because of the siege.

The United Nations humanitarian chief, Valerie Amos, is to brief the UN Security Council on December 3, 2013, on the humanitarian situation in Syria. The Security Council should adopt a resolution demanding access for humanitarian organizations to deliver aid such as food and medicine to the besieged areas, Human Rights Watch said.

“People in Syria are desperate for food, shelter and health care,” said Philippe Bolopion, United Nations director at Human Rights Watch. “Access to besieged communities is a litmus test for real change in the relief effort, and the Security Council should make clear that Syria is failing that test.”

The Security Council issued a non-binding presidential statement on the humanitarian situation on October 2, calling on all sides to facilitate access. Humanitarian organizations have reported that the Syrian government has removed some bureaucratic obstacles but continues to bar access. The Security Council should ratchet up the pressure by adopting a binding resolution and making clear that failure to abide by it will result in targeted sanctions.

Human Rights Watch interviewed 11 local activists and residents from the Old City of Homs, Damascus, and in towns in the Damascus countryside, including Moadamiya, Douma, Yalda, Yarmouk, and Erbin.

The activists and residents said that the Syrian government has for months laid siege to their areas, cutting electricity and communications and preventing food, medicine, and aid workers from reaching civilians in need. Residents from south Damascus, Moadamiya, and Eastern Ghouta said that government forces have tightened the siege in the last several months. A member of the local council in Eastern Ghouta told Human Rights Watch:

Government forces sometimes allowed some people to leave and bring back food and other supplies through a checkpoint in Yarmouk as long as they did not use their cars. Several months ago, however, the soldiers sealed off the checkpoint completely, preventing people from bringing anything in. Since then we have had no bread at all.

International humanitarian organizations told Human Rights Watch that the Syrian government has denied them access to the besieged areas despite repeated requests.

In a briefing to the Security Council on November 1, Amos estimated that 288,000 people were in areas under government siege in Damascus, the Damascus countryside, and Homs.

Local activists and residents in besieged areas told Human Rights Watch that they are experiencing severe food shortages as a result of these restrictions. One local activist in Moadamiya told Human Rights Watch:

The only food we have left is olives, some basic vegetables, and we eat the leaves off the trees. Sometimes we cook soup using some of the vegetables, add salt and pepper and olive oil, but it tastes like nothing and it provides little nutrition. This has been the situation since August when all of Moadamiya ran out of food.

People’s faces are yellow because of malnutrition and all of us have lost a lot of weight. I myself lost about 17 kilograms in the last four months. We start to feel cold very quickly. We can’t fight the low temperatures. That is now one more enemy for us – the cold. It is a terrifying situation. It is a race against time.

While some of the besieged areas contain or are adjacent to farmland, planting and harvesting have become increasingly dangerous because government forces attack anybody they see in the farmlands, the people interviewed told Human Rights Watch. Some said they had lost significant weight because of food shortages.

The medical situation is also dire, local activists and medical personnel said. In some of the besieged areas, government shelling has destroyed local hospitals, forcing medical personnel to treat patients in improvised field clinics. A local activist said that shelling destroyed three hospitals in Moadamiya, for example, and that medical workers were treating all patients in a field clinic in a basement.

Medical workers and local activists in the besieged area told Human Rights Watch that the blockade had prevented them from receiving medicines and medical supplies for months and that they had run out of many basic medical supplies crucial for treating patients, such as blood, antibiotics, bandages, and anesthetics.

It is impossible to verify these accounts because the government has prevented independent human rights observers and humanitarian organizations from accessing the areas.

It is not clear to what extent civilians are being prevented from leaving conflict areas. Civilians have managed to flee some areas under siege and it seems to be possible for civilians to leave at least some areas through government checkpoints. In October, for example, thousands fled Moadamiya, a Damascus suburb under government siege, during a negotiated cease-fire.

But local activists and residents cited several cases in which government forces at checkpoints surrounding Moadamiya, Eastern Ghouta, and the Old City in Homs harassed, attacked, and detained people trying to leave, in particular targeting men of fighting age.

Residents in Yarmouk and the Old City of Homs said that opposition fighters have also restricted the ability of civilians to flee these areas. Others said that the main obstacle to leaving was ongoing fighting. In many cases, people said they do not have financial means to leave their homes and go live somewhere else.

Outside of the besieged areas, the government also refuses to allow humanitarian organizations to deliver aid from Turkey to opposition-controlled areas in northern Syria. Without Syrian consent to enter, some of the major humanitarian organizations, including UN agencies, take unreliable, circuitous routes to reach people in need, sometimes crossing dozens of checkpoints. The UN estimates that 2.5 million people are trapped in such “hard-to-reach” areas.

The Syrian government recently stated that it would allow cross-border aid from Lebanon, Jordan, and Iraq, but not from Turkey. Even this “permission” may not improve the efficacy of humanitarian aid delivery, Human Rights Watch said, since the Syrian government still seems to insist that organizations bring all aid first to Damascus before they distribute it to other parts of the country.

Opposition fighters in northern Syria are preventing humanitarian assistance from reaching tens of thousands of people trapped in two Shia villages just north of the city of Aleppo, the UN has reported. Human Rights Watch was not able to reach any residents of those villages.

Inside Aleppo, which is split between government and opposition control, opposition fighters have from time to time prevented supplies from reaching the government-controlled area. Anti-government groups have also kidnapped aid workers, including employees of the International Committee of the Red Cross, three of whom they still hold.

Under international humanitarian law, all parties to an armed conflict are obligated to facilitate rapid and unimpeded humanitarian assistance to all civilians in need. Starvation as a method of warfare is prohibited.

“As winter weather sets in, the situation in besieged and hard-to-reach areas in Syria becomes even more dire, and people are becoming desperate,” Bolopion said. “There is no time for delay.”

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